Categories
Advocacy Living Donor Protections Living Donor Research Living Kidney Donor

How to Eliminate Some Living Donation Related Costs

Note: Typical with most recently published studies, I’m only able to see the abstract for this one.

 

Authors collected info from 194 living kidney donors enrolled in the KDOC study.

“Most LKDs (n=187, 96%) reported one or more direct costs, including ground transportation (80%), healthcare (24%), lodging (17%) and air transportation (14%)…..Higher total costs were significantly associated with longer distance traveled to the transplant center”

 

As I’ve discussed at length, not only is it not medically necessary for a potential living kidney donor to have their procedure at the same transplant center as their recipient, it can also be detrimental for the kidney donor’s care, recovery and treatment. Transplant centers prefer both parties to be at the same hospital because –

A. It’s convenient for them.

B. Variations in how transplant centers evaluate potential living donors results in a quality control issue. Transplant center 1 might miss something that transplant center 2 deems exclusionary, etc

C. Transplant centers are paid by the procedure, so having folks at different hospitals splits the revenue pie.

D. If the kidney donor and transplant recipient live in different states, there can be insurance and billing conflicts and issues.

 

How to fix the problem (for the living donor, at least):

1. Put *all* treatment for ESRD and kidney failure under Medicare (this would delight private insurance companies btw), or at minimum, have Medicare assume all healthcare expenses if the prospective living donor and would-be recipient reside in different states to circumvent the state insurance regulation obstacles.

2. Completely standardize the living donor evaluation and selection process.

3. Require insurance companies or transplant centers to pay for the living donor’s travel and lodging expenses. (This, however, would still leave the LKD at risk. S/he must return home at some point and could need further treatment)

 

“Few LKDs reported receiving financial support from the transplant candidate (6%), transplant candidate’s family (3%), a nonprofit organization (3%), the National Living Donor Assistance Center (7%), or transplant center (3%).”

Donation is an act of generosity, which causes the prospective LKD to bear the burden (in this case financial) by themselves. Transplant candidates (aka would-be recipients) are taught, in a million subtle ways, to passively accept the sacrifice a donor is making on their behalf. Maybe we need to change the dialogue from one of recipient entitlement to one of recipient responsibility? Rather than expecting the government (NLDAC) or a nonprofit to help with living donation related expenses, transplant candidates should be prepared to assume these costs. If a would-be recipient is unable or unwilling to do, s/he could continue on dialysis and wait until a deceased donor organ becomes available.

If this idea offends your sense of fairness (Poor people won’t get living donor kidneys!), I hear you, but it’s also the reality of how our healthcare system works in general. If someone can’t afford a treatment or medication, that person can’t have that treatment or medication. Is that unfair? Certainly. But then again, one could argue, so is asking another person to act as your medical supply.

 
Rodrigue, J., Schold, J., Morrissey, P., Whiting, J., Vella, J., Kayler, L., Katz, D., Jones, J., Kaplan, B., Fleishman, A., Pavlakis, M., Mandelbrot, D., & , . (2015). Predonation Direct and Indirect Costs Incurred by Adults Who Donated a Kidney: Findings From the KDOC Study American Journal of Transplantation DOI: 10.1111/ajt.13286

Categories
Ethical Considerations Living Kidney Donor Organ Markets

Let’s Hear It For Hubris

A Lebanese transplant surgeon not only engaged in the illegal and unethical practice of taking foreigners big checks and passing along (miniscule) portions of them to a poverty-stricken citizens in exchange for a kidney, he published about it – THREE TIMES.

That’s what we call audacity, my friends.

 

One transplant journal figured it out and retracted three of his papers. You can read about it here:

Transplant journal retracts three papers over possible organ trafficking

Categories
Potpourri Readers Corner

Economic Reality Check

Compliments of Barbara Ehrenreich’s “bright-sided”:

In terms of wealth and income, America became the most polarized of the First World societies and even more deeply divided than it had been in the 1920s. The share of pre-tax income going to the top 1% of American households rose by 7 percentage points from 1979 to 2007, to 16%, while the share of income going to the bottom 80% fell by 7 percentage points.

– CEOs earn an average of $11 million a year.
– Lehman Brothers CEO Richard Fuld made an average $60 million per year between 2000 and 2008.

Between 1965 and 2000, the ratio of CEO to worker pay went from 24:1 to 300:1

Americans are less likely to move upward from their class of origin than are Germans, Canadians, Finns, French, Swedes, Norwegians or Danes.

Categories
Potpourri

As if Big Business Didn’t Have Enough Influence on our Government

The recent Supreme Court ruling interprets the Constitution to equate “money” with “speech”, thereby overturning a century of precedent (including the original ruling on Henry Ford which said that stockholders MUST be paid first – period)allowing corporations to throw as much money as they’d like in support of political campaigns.

Representative Alan Grayson has introduced a number of bills as part of a “Save Our Democracy” initiative to blunt some of the worst implications of the Supreme Court’s decision.

The Business Should Mind Its Own Business Act (H.R. 4431): Implements a 500% excise tax on corporate contributions to political committees, and on corporate expenditures on political advocacy campaigns.

The Public Company Responsibility Act (H.R. 4435): Prevents companies making political contributions and expenditures from trading their stock on national exchanges.

The End Political Kickbacks Act (H.R. 4434): Prevents for-profit corporations that receive government money from making political contributions, and limits the amount that employees of those companies can contribute.

The Corporate Propaganda Sunshine Act (H.R. 4432): Requires publicly traded companies to disclose in SEC filings money used for the purpose of influencing public opinion, rather than for promoting their products and services.

The Ending Corporate Collusion Act (H.R. 4433): Applies antitrust law to industry PACs.

The End the Hijacking of Shareholder Funds Act (H.R. 4487): This bill requires the approval of a majority of a public company’s shareholders for any expenditure by that company to influence public opinion on matters not related to the company’s products or services.

Sign this petition, and/or write/phone/fax your elected representatives to support the above bills.

Categories
Potpourri

Health Care System Problems, One More Time….

http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners.

62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness.

Overall, 78% of the people with a medically-related bankruptcy had health insurance.